BackgroundStroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL’s) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation.MethodsThe VR-based intervention involved a virtual simulation of a city – Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes).ResultsA within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy.ConclusionsOur results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL’s, has more impact than conventional methods.Trial registrationThis trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.

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Objective: To evaluate the incremental efficacy of a Short Message Service (SMS) combined with a brief video intervention in increasing the effects of a health education intervention for cervical cancer prevention, over and beyond a video-alone intervention, with respect to key determinants of health behaviour change – knowledge, motivation and intention. Methodology: Quasi-experimental study design, comparing three conditions – control group, video intervention group and SMS + video intervention group. Participants were 144 Portuguese female college students allocated into one of the three experimental conditions. The effects of the health education interventions were assessed using a theoretically based multidimensional cancer prevention questionnaire. Data were collected at baseline and post-test. Results: Interventions significantly increased the key predictors of adhesion to cancer preventive behaviours. SMS contributed to increases in the expected directions. Evidence of the superiority in efficacy of the combined intervention (SMS + video) over the video-alone intervention was found for cervical cancer screening. Interventions were not as effective in improving intentions and more complex preventive practices such as sexual behaviour as they were in improving knowledge. Conclusion: Results are encouraging in that cervical cancer prevention knowledge and motivation appear modifiable via a one-session video preventive intervention. If, however, the development of intentions is an important predictor of effective behaviour change, study findings point to the added importance of an SMS-based strategy for improving specific cancer preventive behaviours. Findings reinforce the need for specific and tailored health education interventions according to the various determinants of behaviour change, as well as to the particular target behaviour with respect to cervical cancer prevention.

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